The Curbsiders Internal Medicine Podcast #491: Benign Hematology with Brad Beeler
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Jul 14, 2025 Bradley Beeler, an academic hematologist and program director in San Antonio, shares his expertise in benign hematology. He discusses how to decode low neutrophil counts and the nuances of thalassemia without unnecessary testing. The conversation dives into managing bleeding disorders, with practical advice on assessing patient histories and utilizing bleeding assessment tools effectively. Beeler emphasizes the importance of understanding ethnic variations in lab results and offers strategies for navigating the complexities of chronic anemia.
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Duffy-null Neutropenia Explained
- Duffy-null-associated neutropenia (DANC) is a common, benign genetic polymorphism causing low neutrophil count without increased infection risk.
- This condition is prevalent in African and Middle Eastern populations and does not usually require extensive workup if asymptomatic.
Managing Low Neutrophil Counts
- Observe asymptomatic patients with ANC around 1,000 to 1,500 without immediate need for invasive testing.
- Refer to hematology if ANC is below 1,000 or symptoms develop; genetic testing for DANC is costly and not routinely necessary.
Apply Bleeding Assessment Tool
- Use the bleeding assessment tool (BAT) in primary care to quantify bleeding risk and decide on hematology referral.
- A BAT score ≥4 in men and ≥6 in women suggests an atypical bleeder needing specialist evaluation.